Scoliosis Surgery Cost: Scoliosis Spinal Fusion Surgery and Alternatives
Scoliosis correction surgery has increased in frequency over the last two decades with the most common reason for scoliosis surgical recommendation being adolescent idiopathic scoliosis 3. As you would imagine, the scoliosis operation cost, or scoliosis surgery cost can be significant. But does the cost balance the benefit? How much does a surgery for scoliosis cost? Here we discuss the cost of surgery for scoliosis, how it has changed over time, the costs of conservative non-surgical treatment, and how these compare.
Surgical treatment for idiopathic scoliosis has traditionally consisted of some degree of spinal fusion surgery with more recent advances in minimally invasive surgical techniques including options such as vertebral tethering. While recent scientific studies have proven bracing as an effective treatment for idiopathic scoliosis, previously many doctors moved away from bracing opting for the now outdated concept of “watch and wait” until the scoliosis worsened to the point of requiring scoliosis correction surgery; in part due to a lack of scientific studies on modern braces, difficulties with compliance (patients wearing their braces), lead surgeons recommending surgery, and other factors.
Surgery for Scoliosis: How frequently does it happen?
Because this article is about the overall cost of surgery for the treatment of scoliosis, it is important to first discuss how often complications occur, and whether these require a second or “revision” surgery. Thus when we talk about scoliosis surgery cost we need to look at the whole picture and not just the initial surgery cost. This would include any revision surgeries and their costs; the costs of office visits and physical therapy / rehabilitation after surgery; as well as circumstances which increase cost such as a longer stay in the hospital or larger areas of the spine being fused during surgery.
While the frequency of scoliosis as a disease has not significantly changed, there has been a significant increase (almost a 2 fold increase) in scoliosis correction surgery since the year 2000 3. There have also been dramatic increases in spinal fusion surgery in general within the United States since 1998 5. What is interesting is that while surgery for scoliosis has increased, there has also been a decrease in the time spent in the hospital for the surgical treatment of scoliosis (length of stay or LOS) 3, 6. Happily, there has also been a slight decrease (0.04%) in spinal fusion surgery related deaths since 1998 5. However, this is not to say that surgery does not carry risks of complications and the necessity of a second or “revision” surgery.
One review from 2008 found that scoliosis correction surgery had a “varying but high rate of complications” 7. This review, now over 10 years old looked at over 280 scientific studies which described complication rates for the surgical treatment of scoliosis. While some studies analyzed by the review had zero complications, others had complication rates as high as 89%. What about more recent studies? And what sort of “complications” do they mean?
What about new research?
A new study published this year (2019) looked at how often the hardware (rods, screws and other spinal instrumentation) have to be removed AFTER scoliosis surgery is performed. The scientific study looked at over 1100 surgeries over 22 years (1992-2016) and found that almost 5% of patients required their hardware to be removed. The “complications” that occurred and thus required the revision surgery to remove the hardware vary, but the number one complication? Infection. In fact, 46% of patients who needed their hardware removed after scoliosis correction surgery needed to do so because of infection. Other complications included long lasting pain and metal intolerance 1.
If we look at adults who have surgery for severe scoliosis, we find even higher complication rates. Another new study from 2019 2 looked at adults (ages 46 to 68 on average) with curves 75 degrees or larger who had spinal fusion performed and found 32% of these patients required a second (revision) surgery. Over 25% of these patients sadly experienced a fracture of one of their rods or pseudarthrosis and 36% experienced some sort of neurological problem immediately after surgery. It is also important to note that their curves were reduced on average 66%. While this is good, it also provides yet another example that even surgeons are limited in truly straightening the spine, even when they physically cut out portions of the spine and its connecting tissues!
Scoliosis Operation Costs: How have they changed?
It is surprising to learn that the overall cost of spinal fusion has increased almost 8 fold in the United States since 1998 as of 2008 5. When we look at only the hospital charges as part of the national bill for spinal fusion we see that it has increased more than 3 fold from 1998-2008. Since the length of time a patient spends in the hospital has decreased, and surgical techniques have supposedly improved, one might think that this would bring the cost down or that it would at least stay the same relative to inflation. However this is not the case at all.
One study from a couple of years ago (2017) 6 found that while length of stay in the hospital decreased by about one day, the hospital charges increased by more than 3 fold from approximately $55,000 in 1997 to over $175,000 in 2012. Considering inflation from 1997-2012 should only increase our $55,000 bill to a $79,000+ bill, we still have over $96,000 in hospital bills which have magically appeared over the last 20 years. This simply doesn’t make sense. We have more patients than ever before being referred for scoliosis correction surgery, the length of time they are spending in the hospital decreasing, and yet the bill continues to skyrocket for patients and their families.
The 90 Day Scoliosis Surgery Cost
If you have ever shopped around for a new car, you may have heard the phrase “total cost of ownership.” This is a cost that is designed to educate and inform someone shopping for a car what they might expect to pay over a five or ten year period for their car. From oil changes to gas, it helps provide a better “apples to apples” comparison when you might be comparing costs for a large truck to a small compact car.
Patients who choose to undergo surgery as a treatment for their scoliosis need to consider the overall cost of the surgery, but long term costs also must be considered. While 90 days certainly is not a long term period of time by any means, it still covers that period of time immediately after surgery where immediate complications may arise as well as their added costs. How insurance companies, Medicaid, and other payment assistance plays a role is also important as this can significantly change the total bill a patient receives.
A New Scientific Study on Cost
A new study published this year (2019) 4 performed a thorough analysis of costs over a 90 day period after spinal fusion surgery. Specifically, the cost of posterior spinal fusions for adolescent idiopathic scoliosis patients was analyzed over a period of nine years (2007-2016) which included:
|• Facility Costs||• Surgeon Costs||• Anesthesia Costs||• Intra-operative Neuromonitoring Costs|
|• Hospital Service Costs||• Investigation Costs||• Intensive Care Costs||• Radiology (x-ray and MRI) Costs|
|• Physical Therapy Costs||• Rehabilitation Costs||• Office Visit Costs|
And last but not least, any costs associated with readmissions. The 90 day scoliosis surgery cost they found was over $120,000 on average, with “bundled” prices being $136,302 for patients with insurance and $62,871 for patients with Medicaid. As you might imagine, the majority of these costs were facility costs (using hospital facilities) which made up 85% to 92% of the total cost followed by the surgeon’s costs which were approximately 5% to 6% of the total cost.
It is interesting to learn that costs associated with physical therapy and rehabilitation only made up less than half a percent of the total scoliosis surgery cost. Another interesting finding was predictors for a significantly higher total bill. A scoliosis operation cost increased by approximately $11,000 when patients had other health problems (co-morbidity burden) and increased by approximately $5,300 a day when they needed to stay at the hospital longer. While patients with Medicaid enjoyed a significantly lower bill (saving $80,000 on average), patients who required more than seven levels of spinal fusion during scoliosis correction surgery found their bills significantly higher with a $65,000 increase in cost.
Scoliosis Surgery Cost and Benefit?
We know that some scoliosis patients will require surgery, plain and simple. This is because some cases are complex with co-morbidities (ie. neuromuscular, syndromic) or they are discovered too late and are very severe, thus requiring surgical correction. After all, no two cases of scoliosis are the same.
However, we also know that when we catch scoliosis early, and treat it conservatively with bracing, physiotherapeutic scoliosis specific exercises, and do so through skeletal maturity, that we can prevent surgery. By taking this proactive, scientifically validated approach, we can also help straighten the spine, and provide long lasting treatment results 15+ years down the road. Bracing based approaches have the added benefit of not removing any structural components of the spine. This includes ligaments, joints and portions of the spine (interspinous ligaments, facet joints, and portions of the spinous process) which are removed during spinal fusion surgery. This is all the more important when surgery fails because when hardware is removed, this isn’t the end of the story as those structural components of the spine have been permanently destroyed as well.
The quick and inexpensive fix?
While it is true than insurance companies tend to cover surgery for scoliosis while more conservative treatments are left uncovered, there are still SUBSTANTIAL costs associated with either treatment decision. Every patient and their family must make an educated, well-informed decision that balances their current quality of life and well being; their future quality of life and well being; time and rehabilitation; and of course, money.
Surgery is recommended more now than it was 20 years ago however, it is very frequently misunderstood as a “quick fix” when there is nothing quick about it. You still are having a major surgery performed requiring anesthesia; you will still require physical therapy and rehabilitation; you will have permanent changes made to your spine (in the case of spinal fusion); the surgeon is still limited in how straight they can make the spine; and you may still need additional surgeries in the future. Simply put, surgery is simply another treatment option to be considered with its own risks and costs. Surgery IS NOT AND NEVER HAS BEEN a “quick and easy fix” to straighten the spine completely.
Scoliosis Surgery Cost - Take Home Messages
We know that surgery, just like all other treatment options for scoliosis has its costs and benefits. We also understand that for some, surgery may be one of their only options, while for most it can be avoided. We know that scoliosis surgery cost can easily skyrocket over $100,000 and has increased in cost far faster than inflation. We also know that non-surgical treatment has its own costs, and is not cheap either. After all, we are talking about custom braces, physical therapy, MRI imaging, x-rays, and a doctor’s time which quickly add up and are certainly a far cry from a routine runny nose at the doctor’s office. But what are the benefits we gain?
For one, non-surgical treatment for scoliosis has a lower overall cost than surgery. Assuming that time and money are not wasted on treatments which are not scientifically supported and do not work, it would be extremely difficult to spend over $120,000 on scoliosis braces and office visits for adolescent idiopathic scoliosis. You also gain the benefit of not disrupting the spine and its structural integrity. The old adage of “if it isn’t broken don’t fix it” rings true here: we need to straighten the spine, not remove all of the joints, ligaments, and portions of the spine if don’t absolutely have to. You also eliminate any risk of infection, rod breakage, or metal rejection because in the end, we never had to insert hardware into the body.
If we have the same $100,000+ budget for our scoliosis surgery cost as we do for our non-surgical scoliosis treatment cost, and we don’t have any co-morbidities or other problems that would REQUIRE surgery, then the treatment decision becomes clear. Even if insurance companies don’t cover the whole bill, the cost benefit of non-surgical treatment quickly outweighs that for surgery. We get to maintain the integrity of our spine, while spending less money overall, with fewer risks, but we have to do a little bit more work by wearing a brace and doing exercises.
Seems like a pretty fair deal doesn’t it?
1. Abola, Matthew V.; Hardesty, Christina K.; Knapik, Derrick M.; Poe-Kochert, Connie; Son-Hing, Jochen P.; Thompson, George H. (2019): Incidence of complete spinal instrumentation removal following surgery for spinal deformity. A 22-year single institution study. In Journal of pediatric orthopedics. Part B 28 (4), pp. 380–384. DOI: 10.1097/BPB.0000000000000605. Read the article
2. Buell, Thomas J.; Chen, Ching-Jen; Nguyen, James H.; Christiansen, Peter A.; Murthy, Saikiran G.; Buchholz, Avery L. et al. (2019): Surgical correction of severe adult lumbar scoliosis (major curves ≥ 75°). Retrospective analysis with minimum 2-year follow-up. In Journal of neurosurgery. Spine, pp. 1–14. DOI: 10.3171/2019.3.SPINE1966. Read the article
3. Heideken, Johan von; Iversen, Maura D.; Gerdhem, Paul (2018): Rapidly increasing incidence in scoliosis surgery over 14 years in a nationwide sample. In European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 27 (2), pp. 286–292. DOI: 10.1007/s00586-017-5346-6. Read the article
4. Malik, Azeem Tariq; Yu, Elizabeth; Kim, Jeffery; Khan, Safdar N. (2019): Understanding Costs in a 90-day Episode of Care following Posterior Spinal Fusions for Adolescent Idiopathic Scoliosis (AIS). In World neurosurgery. DOI: 1016/j.wneu.2019.06.149. Read the article
5. Rajaee, Sean S.; Bae, Hyun W.; Kanim, Linda E. A.; Delamarter, Rick B. (2012): Spinal fusion in the United States. Analysis of trends from 1998 to 2008. In Spine 37 (1), pp. 67–76. DOI: 10.1097/BRS.0b013e31820cccfb. Read the article
6. Raudenbush, Brandon L.; Gurd, David P.; Goodwin, Ryan C.; Kuivila, Thomas E.; Ballock, R. Tracy (2017): Cost analysis of adolescent idiopathic scoliosis surgery. Early discharge decreases hospital costs much less than intraoperative variables under the control of the surgeon. In Journal of spine surgery (Hong Kong) 3 (1), pp. 50–57. DOI: 10.21037/jss.2017.03.11. Read the article
7. Weiss, Hans-Rudolf; Goodall, Deborah (2008): Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. In Scoliosis 3, p. 9. DOI: 10.1186/1748-7161-3-9. Read the article